Sally Gainsbury: a cunning plot, outed

The conspiracy theorists were busy earlier this month proposing that Monitor had deliberately “buried” its updated financial assumptions over the bank holiday weekend.

“Burying bad news” is journalese for “we missed this, but hope that by sticking a fresh conspiracy line in the story, you won’t notice”.

HSJ, of course, needed no such excuse, as it had published the story before the first string of royal bunting had been tied.

Those familiar with the relationship history between the Department of Health and Monitor will not easily imagine the regulator going out of its way to help the DH out of its public relations hole.

But that’s not to say there was no conspiracy. Monitor’s letter had all the hallmarks of a cunning plot, including outright denial. It said those scary numbers “are not intended to provide any basis for commercial decisions made between providers and commissioners within the NHS, including contract negotiations”.

Funny that, because the figures – setting out just how hard trusts will find the coming years – came as contract negotiations between some commissioners and foundation trusts had become tortuous, not least because primary care trust clustering has brought commissioners negotiating clout.

Indeed, NHS North Central London has shown truly world class credentials by threatening to shift intransigent trusts from a pay in advance, validate later basis to “pay as you go”, which would be more accurately described as “pay two months after the fact”.

It could leave hospitals with no cash to pay staff – a pretty good “lever” when you want an FT to sign up to a harsh deal. Pity that North Central London picked its biggest fight with University College London Hospitals FT, whose cash balance has ranged from £60m-£80m lately – at least two months’ worth of staff pay – before having to touch the overdraft or flog real estate.